MedicDude Posted October 22, 2006 Share Posted October 22, 2006 Hey guys, I had one slightly embarassing incident happen while I was doing my practical-based midterm test. Luckily it didn't affect any grades, and nobody saw me do it, but still... My face was a little red... You see, the primary care medical directives (aka protocols) in Ontario state that we can give nebulized epi for children with croup, who have stridor and moderate-severe respiratory distress. The maximum dose is 5mg NEB. In our scenario, I was the secondary (aka driver) so I was the one getting all the equipment together. Since this "kid" in our scenario was 6 years old, it called for the maximum dose of 5 mg. The thing is, our epi is stored in 1:1000 1mg glass ampoules. Therefore, 5mg required me to draw from 5 ampoules. Ok, so far so good. I started drawing up the epi from the ampoules with a 1cc syringe, and injecting it into the nebulizer. Unfortunately, when I injected it, I think I was a little overzealous and caused the needle to come off the end of the syringe! Luckily, nobody was looking, and I promptly grabbed another one. We were able to successfully complete the scenario. My questions for you are the following: 1. Is there a better way to get the epi into the nebulizer? 2. should I insist that we only use "Luer-Lok" syringes? 3. Or, should I just make sure the needle is on securely and try not to do a gorilla impression on the syringe? Your ideas are greatly appreciated! Link to comment Share on other sites More sharing options...
AZCEP Posted October 22, 2006 Share Posted October 22, 2006 Multi-dose vials are a nice way around your problem with the ampules, but if they aren't available you will be out of luck. I would suggest making sure the needle is securely threaded onto the syringe beforehand. If this happened during this situation, you might have it happen during an administration of an IV medication as well. When you are injecting into an SVN, it is generally better to slow down a bit so the medication doesn't splash. Sounds like a bit of all three of your suggestions would be the ticket. Link to comment Share on other sites More sharing options...
TEMTP Posted October 22, 2006 Share Posted October 22, 2006 Out of curiosity would you be able to insert the syringe into the opening of the ampule as you have the ampule upside down? I wonder if that would work. I mean you don't need the needle to push the epi into the neb as you would for a shot. Link to comment Share on other sites More sharing options...
akroeze Posted October 22, 2006 Share Posted October 22, 2006 Hey guys, I had one slightly embarassing incident happen while I was doing my practical-based midterm test. Luckily it didn't affect any grades, and nobody saw me do it, but still... My face was a little red... You see, the primary care medical directives (aka protocols) in Ontario state that we can give nebulized epi for children with croup, who have stridor and moderate-severe respiratory distress. The maximum dose is 5mg NEB. In our scenario, I was the secondary (aka driver) so I was the one getting all the equipment together. Since this "kid" in our scenario was 6 years old, it called for the maximum dose of 5 mg. The thing is, our epi is stored in 1:1000 1mg glass ampoules. Therefore, 5mg required me to draw from 5 ampoules. Ok, so far so good. I started drawing up the epi from the ampoules with a 1cc syringe, and injecting it into the nebulizer. Unfortunately, when I injected it, I think I was a little overzealous and caused the needle to come off the end of the syringe! Luckily, nobody was looking, and I promptly grabbed another one. We were able to successfully complete the scenario. My questions for you are the following: 1. Is there a better way to get the epi into the nebulizer? 2. should I insist that we only use "Luer-Lok" syringes? 3. Or, should I just make sure the needle is on securely and try not to do a gorilla impression on the syringe? Your ideas are greatly appreciated! I had a similar situation, but more of a "this is taking forever" thing since each draw requires ensuring that you have exactly 1mL :? Would be so much easier if they would carry either multi-dose or make a 5mg amp. Then you just need to draw up the 2.5 out of that as well. Link to comment Share on other sites More sharing options...
hammerpcp Posted October 23, 2006 Share Posted October 23, 2006 Okay so here's how you do it. Get a ten ml syringe and a vial access canula. Set up your "safe area", eg a table that no one is going to bump, and get out your sharps container of course. line up your little epi ampules, crack crack crack crack crack, draw draw draw draw draw, and empty syringe into neb. Alternatively you can do it crack draw, crack draw, crack draw etc. but then you have to ut down the syringe in between. I haven't found a better way to do this, and using a vial access or blunt plastic cannula minimizes the amount of sharps you are using. Link to comment Share on other sites More sharing options...
MedicDude Posted October 29, 2006 Author Share Posted October 29, 2006 Exactly! Another problem is the amount of sharps you have to handle in that situation... I'll definitely look into using a cannula for next time though. Either that or using just the syringe, sans the needle. Of course, that means I'd have to hold the ampoule upside-down and draw from underneath, but it could work... Nice suggestions, fellas! Also, when I'm in the lab or hospital, finding a good working surface for drawing up meds is easy. However, what about on a call, in a residence? Should I clear off a coffee table or something? I'm interested to know what happens in real life... Link to comment Share on other sites More sharing options...
hammerpcp Posted October 29, 2006 Share Posted October 29, 2006 Exactly! Another problem is the amount of sharps you have to handle in that situation... I'll definitely look into using a cannula for next time though. Either that or using just the syringe, sans the needle. Of course, that means I'd have to hold the ampoule upside-down and draw from underneath, but it could work... Nice suggestions, fellas! Also, when I'm in the lab or hospital, finding a good working surface for drawing up meds is easy. However, what about on a call, in a residence? Should I clear off a coffee table or something? I'm interested to know what happens in real life... In real life no one ever gives nebulized epi, so don't worry about it. Link to comment Share on other sites More sharing options...
northernmedic Posted October 29, 2006 Share Posted October 29, 2006 Get your boss to order the 10cc multidose vials of 1:1000 epi. That's mostly what we use and it's way easier. Link to comment Share on other sites More sharing options...
Recommended Posts